The History of Diabetes

1. In 1500 BCE, ancient Egyptians recognized diabetes in people who urinated frequently and lost weight for no apparent reason. It was not labeled at that time but it existed.
2. A Greek physician named Arateaus recognized that the urine produced from people with diabetes was sweet and termed it Diabetes Mellitus.
3. In 1776, Matthew Dobson actually measured the urine for glucose and found it to be increased in certain people.
4. In the early 1800s, diabetes was considered a clinical entity but the prevalence was not really documented. No specific treatment was used and usually within weeks to months the disease was fatal.
5. The last 200 years have helped us understand many of the underlying causes of diabetes, ways to decrease risk factors of diabetes, and actual treatments. The outlook has definitely improved, with good results when therapies are used.
6. Treatments have been effective, but still no real cure has been discovered.
7. The disease of ancient times involved insulin deficiency (Type 1).
8. In the early 1900s, Edward Sharpey-Schafer thought the lack of insulin was the cause of diabetes.
9. Frederick Bating and Charles Best discovered insulin by reversing diabetes in dogs after inducing it. They did this by extracting pancreatic islet cells from healthy dogs; they later purified the insulin, and along with James Collip and John Macleod, were the first to treat a patient with diabetes using insulin.
10. In 1936, Harold Himsworth proposed that more people had insulin resistance than insulin deficiency (Type 2).
11. The discovery of biosynthetic human insulin replaced animal insulin, which eliminated reactions to insulin.
12. Over the years we went from checking glucose in urine samples to using glucometers and checking blood sugar. In the beginning, blood glucose meter were only available in the hospital. Over time they became smaller, more sophisticated, and were made available for home use.
13. New classes of oral diabetes medication have been discovered working on the pancreas, liver, muscle cells, gut hormones, and kidneys. Some that remain are cheap and reliable, and some are gone due to excessive side effects.
14. Insulin injections went from glass syringes and long needles (which needed to be sterilized and reused), to disposable syringes with short, attached needles. Even easier are the disposable insulin pens which just require the click of a button.
15. Pumps have made many lives much easier and eliminate the need for multiple daily shots. The added flexibility helps with an easier meal plan and exercise plan.
16. Continuous Glucose Monitoring (CGM) assists people in identifying blood sugar trends, and is crucial for those who suffer from hypoglycemic unawareness.
17. Ketone testing has gone from testing urine with strips to blood ketone testing, which is more efficient and reliable for testing for Diabetic Ketoacidosis (DKA).
18. New injectable medications - called GLP1s - have been developed to not only assist with blood sugar control, but with appetite suppression and weight management - a huge asset for people with diabetes.
19. Bariatric surgery has been added as a treatment for extremely overweight people with diabetes. Good results have been seen.
20. New technology and medications are always being developed since diabetes is big business. The future looks bright. Hopefully we will gain progress in the fight against diabetes.
21. On the darker side - 2012 shows that insulin deficiency (Type 1) accounts for 10% of diagnosed cases (autoimmune) which can be controlled with exogenous insulin (insulin injections). About 90% of the cases are considered insulin resistance (Type 2). This has become evident in the past 40 years and has created an epidemic world wide (causes may include inactivity, food portions and weight gain, along with genetics).
22. The most recent statistics from the ADA are: 26 million people in the US have diabetes; 79 million have pre-diabetes with an increased risk for diabetes. One in three will have diabetes in 2050 if dramatic changes are not achieved. The yearly cost of diabetes to the nation is $174 billion.
23. The need for a team approach with multiple follow up appointments has proven results, whether in person (one on one, class) or on the phone. Having a physician, CDE, dietitian, social worker, podiatrist, pharmacist and ophthalmologist is the best way to follow all the organ systems involved in diabetes.

Weight Gain and Diabetes

1. Stress - There are two ways that emotional or mental stress can add to weight gain. One way is that many people are "stress eaters." What exactly does that mean? It means that with emotional comfort or discomfort including anxiety, guilt, depression, happiness or generalized stress you tend to grab for food - especially comfort food; comfort foods including meat loaf, macaroni and cheese, mashed potatoes and fruit cobblers tend to fit the profile. Obviously people who eat out of emotion tend to gain more weight as opposed to those who eat out of hunger and show self control. The box of cookies or the bag of chips automatically disappears without realization and then the weight piles on. The second way is when you are stressed the hormones pour out, especially cortisol, and the weight comes on. Cortisol is the fight or flight hormone which increases heart rate, opens your blood vessels, diverts blood from your digestive system and sends blood to your muscles. Your liver also increases the release of glycogen (or stored sugar) into the system to help you run away. The body now has no need for this extra sugar and it is stored in fat cells. You feel more hungry, eat more, and store more sugar in the fat cells. This response becomes chronic and the weight gain begins - especially around the middle and the internal organs. This is called visceral fat. Can we stop stress from happening? Most likely not but you can change your response to stress to avoid unnecessary weight gain. Consider ways to reduce or alleviate stress as much as possible or find ways to cope with it.
2. Thrifty gene hypothesis - This hypothesis was introduced in 1962 by geneticist Dr. James Neel. The concept is that the human developed the thrifty gene to help during times of famine. As time progressed and the ability to gather or purchase food was further developed the need for this gene was no longer apparent. The "thrifty gene allowed us to store and process food when food was most plentiful." The thrifty gene seems to present itself in specific populations where food was difficult to come by. Unfortunately this hypothesis has been explored by many other scientists and it is said that it most likely does not exist. Research continues to explore this hypothesis.
3. Menopause and Andropause (male menopause) - As we age we tend to put on weight due to an imbalance of hormones. This hormone imbalance also has an effect on your appetite, hunger, fat storage and metabolic rate. For women, estrogen starts to decline about 10-12 years prior to menopause. The body begins to search for more estrogen and finds it from fat cells. Your body converts more calories to fat to keep up with the need for estrogen and you gain weight - especially around the middle. Women lose the production of progesterone, another hormone which causes water retention, bloating and weight gain. Although much less critical to women, testosterone levels drop during menopause; as we lose testosterone we lose the ability to build muscle mass, which helps keep up our metabolic rate. The weight accumulates as we lose muscle mass. Men have their own hormonal reasons for weight gain. As they age they tend to produce more estrogen and less testosterone. This make them lose muscle mass and end up gaining weight. Some estrogen is necessary for men to assist in producing bone mass but too much causes fat cell deposits. You should talk to your physician to see how to deal with these issues. Blood sugars are affected during this phase of life due to hormones and should be considered in your overall treatment plans.
4. Thyroid - Hypothyroidism, or under-active thyroid, can be a cause of weight gain if unrecognized or untreated. It is more common in women and in combination with diabetes since it is an auto-immune disease. Thyroid disease tends to run in families and increases in frequency as we age. Too little thyroid hormone can definitely cause weight gain, uncontrolled blood sugars, hair loss, dry skin, constipation, mental fog, fluid retention and stiffness. Your health care provider should be checking your thyroid blood work at least yearly for abnormalities.

Blood Sugar Basics

1. What is the recommended number of grams of sugar that an adult male, adult female, and child should have in their daily diet?
   
   The Institute of Medicine recommends that we consume about 45 percent to 65 percent of calories from carbohydrates. If you eat about 1,500 calories a day that means about 169-225 grams of carbohydrate/day. Of course, this is an estimate and will vary with age, physical activity, health conditions, etc. Individuals should work with their healthcare team to determine what might be most appropriate for them. Education is key in living well with type 2 diabetes. That's why I'm partnering with the American College of Endocrinology and Merck to launch a new Blood Sugar Basics program called The Game Plan, which offers four easy-to-understand goals to help people manage their type 2 diabetes. Creating a specific and personalized game plan and setting goals is a huge part of managing diabetes.
   
   BloodSugarBasics.com offers this helpful online guide:
   • During the first goal (Huddle), you meet with your diabetes healthcare team to set goals;
   • With the second goal (Enter the Nutrition Zone), you focus on healthy eating and meal planning;
   • The third goal (Get in the Game) helps you find easy ways to get more active; and
   • During the last goal (Check the Scoreboard), you look back on your progress and continue to work toward and/or maintain your goals.
2. Does that number differ when the person has diabetes? If so, how?
   
   The American Diabetes Association recommends that people with type 2 diabetes start with about 45-60 grams of carbohydrate per meal. The amount of carbohydrate will vary depending on your blood sugar control, weight and physical activity. Your health care team will work with you to decide what is best for you. It is important to remember that carbohydrates include starchy foods such as bread, rice and pasta as well as vegetables, fruits, yogurt, milk and legumes. Sodas, desserts, candy and chips are loaded with refined carbohydrates that can wreak havoc with blood sugars. One serving of carbohydrate equals 15 grams. Check out goal number 2 of The Game Plan, "Enter the Nutrition Zone," for more tips on ways to maintain a healthy diet.
3. We're trained to read nutrition labels so we know the content of items we are consuming. When it comes to sugar, is there a way to distinguish between natural sugars VS added sugars?
   
   Added sugars are defined as: those incorporated into foods and beverages during production which usually provide insignificant amounts of vitamins, minerals, or other essential nutrients. Major sources include soft drinks, fruit drinks, pastries, candy, and other sweets.
4. What are some of the most common names of added sugars we should become familiar with?
   
   Reading the ingredient list on food labels is important. It is requires that ingredients be listed by weight, from most to least. There are a lot of names for added sugars. The more common ones include, but are not limited to: agave nectar, anhydrous dextrose, brown sugar, cane crystals, cane sugar, confectioner's powdered sugar, corn sweetener, corn syrup, crystalline fructose, dextrose, evaporated cane juice, fructose, fruit juice concentrate, glucose, high-fructose corn syrup, honey, invert sugar, lactose, maltose, malt syrup, molasses, nectar, raw sugar, sucrose, sugar including raw, and syrup.
5. Of the names on that list, are there some that we should absolutely avoid? Do any of them provide valuable nutrition?
   
   People with type 2 diabetes can consume foods that have some added sugars but you must look at your food intake as a whole and not just from snack to snack or meal. Keeping track of what you eat is an essential part of managing blood sugars and weight. Blood Sugar Basics has a great, free Healthy Meals & Snacks Planner that will help you track your intake, manage both high and low blood sugar, and weight, and be a more mindful eater.
6. If a product claims to have 10 grams of sugar per serving, how are we to know how many grams are from natural VS added sugars?
   
   You can't tell just by looking at the nutrition facts panel of a food if it contains added sugars. The line for "sugars" includes both added and natural sugars. People with type 2 diabetes need to look at Total Grams of Carbohydrate per serving, not the ‘sugars' line on the label.
   
   REMEMBER: Diabetes is not just about dietary sugars. Understanding the ABC's of diabetes will help you stay healthy and minimize complications associated with type 2 diabetes. Blood Sugar Basics emphasizes these ABCs:
   • A1C (blood sugar measurement over 2-3 months)
   • Blood Pressure
   • Cholesterol
7. Name 4 commonly consumed foods that should be avoided strictly due to the high amount of added sugars.
   
   Sodas, sugar sweetened beverages (e.g. fruit drinks, sweetened teas, punch), low fat sweets such as muffins, cakes and cookies, and sugary cereals.
8. Now name 4 foods that can replace those 4 that have much greater health benefits due to their nutritional content.
   
   Seltzers, water, herbal teas, whole grain, homemade sweets (in limited amounts) and 100% whole grain cereals without extra sugars (e.g. shredded wheat, oatmeal.)

Weight Gain and Diabetes

1. BPA exposure - Bisphenol A (or BPA) has recently been in the news. It is contained in certain plastic water bottles as well as on the insides of soup, fish, chicken and vegetable cans. It can be found in other beverages packaged in cans, plastic food containers, and paper receipts from the supermarket, boarding passes, credit/debit charge receipts and most paper tickets. A study done by Spanish researchers reported an interesting correlation. They exposed human pancreatic cells (where insulin is made) to tiny amounts of BPA. It caused the cells to double the amount of insulin needed to metabolize the sugar in the meal. In time excess insulin or hyper insulinemia can encourage the body to store more fat especially around the waist line. There really is no standardized or routine testing of BPA, but according to Dr. H Taylor, a reproductive endocrinologist at Yale University, most Americans have high levels of BPA circulating in the blood. The best idea is to reduce BPA exposure. Choose fresh or frozen fruits and vegetables instead of those in a can. Choose glass over plastic for drinking or find BPA free plastic bottles. Try to reheat foods in glass or on microwave safe dishes instead of plastic containers. Store or freeze foods in glass instead of plastic. Think about what you can do online for ticket purchases so you can print them out on BPA-free paper.
2. Medications have been known to put extra weight on. There are medications called SSRIs or Selective Serotonin Reuptake Inhibitors. Examples would be Paxil, Pexeva, or Celexa. These anti-depressants - used to treat anxiety or depression - have been known to increase appetite. Your physician could change to another type or brand that increases dopamine, which may reduce hunger (e.g. Wellbutrin). Certain blood pressure medications can also lead to weight gain since they may decrease a person's metabolic rate. Beta blockers such as Tenormin or Lopressor can add weight, but ARBS or ACE inhibitors usually do not. You need to check with your physician to find out which is the most appropriate blood pressure medication for you. Many types of anti-histamines used to treat allergies like Benadryl or Alka Seltzer plus Allergy may increase hunger. Other choices which contain less potent chemicals including Claritin or Zyrtec can cause less of an appetite. Medications for sleep disturbance can increase appetite and weight gain if used daily. Instead of OTC brands like Sominex or Nytol ask for a prescription of Ambien and try not to take it nightly. Insulin causes weight gain since it helps you use the sugar from the food by getting it into the cells instead of excreting it through the urine. Never stop taking insulin for this reason. Diabetes oral medications called Sulfonylurea's (Glipizide, Glyburide and Glimiperide) are known to promote weight gain as well as TZDs - Actos and Avandia (black boxed-not really being prescribed anymore due to multiple side effects). This is just a short list and I am sure there are many more medications which may cause weight gain - but you must weigh the benefits and risks with your physician; never change or go off medications without checking with your health care provider!
3. Addictive foods - New research suggests that certain foods can be addictive just like drugs and alcohol. Studies using both sugar and fat show that over time larger doses of these foods were required to get that same "feel good" sensation. According to Dr. Brownell from Yale University, the human body is adapted to deal with natural food and when presented with processed food the mental and physical addiction takes over - along with the weight gain. Gaining pleasure from food is important, but indulging in a roasted peach instead of a bag of chips will be a positive measure. The less sugar and fat you eat will allow you to experience fewer cravings!
4. Another possible cause of weight gain is systemic inflammation. Inflammation means the body's immune system works overtime and can interfere with a hormone called Leptin; in a person of average weight, leptin can decrease appetite and increase metabolism. In an over weight person the leptin signal can get lost. Inflammation can result from stress, excess sun, sedentary life style, disease processes or food additives. Foods such as salmon, almonds, egg whites or apples may decrease inflammation as well as Omega 3 fish oil or supplements.

Finding Sugar in Hidden Places - For Better Diabetes Management

1. Jarred pasta sauces - Tomatoes are a good source of lycopene (a great anti-oxidant) especially when they are cooked or in sauces. It is known to lower the risk of prostate cancer and heart disease. Remember to look at labels and see what order the ingredients are in. Those that are the largest amount are listed first. Make sure the label says tomatoes, tomato puree or tomato products as the primary ingredients. Compare amounts of sugar in your product.
2. Yogurt - Yogurt is a fabulous food for almost everyone but not when it has a ton of added sugars. If it says "Double chocolate creamy rich yogurt" you can bet it has added sugar. Flavors like vanilla, lemon and coffee also tend to have added sugar. Some yogurts have up to 50% added sugar. Watch yogurt with "fruit on the bottom" since it is not real fruit but fruit concentrate with added sugars. Look for low fat/light types or stick to natural or plain yogurt and add your own fruits, nuts and a dash of cinnamon. Plain yogurt has more potassium which is a benefit to most. Try to find one with 15 grams of sugar since the first 12 grams are from the actual yogurt.
3. Oatmeal - Oatmeal is an excellent choice since it contains fiber, helps you have a full feeling and can reduce your cholesterol. The problem comes when the assorted single packages are flavored and loaded with added sugar. Flavors like Berry Crunch, Maple Walnut or Brown Sugar are a dead giveaway. There are 4 teaspoons of sugar in the flavored choices. Again try plain and add your own toppings or get the low sugar variety if you can not tolerate the plain.
4. Juice cocktails - Most know that regular soda is not on the go to list for beverages when you have diabetes but forget about regular fruit juices as well. There are diet brands available and you may need some time to get used to them but you will be cutting over 7 teaspoons of sugar if you give up grape, cranberry, apple or other regular fruit juices.
5. Fat free salad dressings and generally fat free packaged products - Many times a reduction in fat means an increase in sugar to replace the taste. They will also load up on sodium to give back the flavor. Read the labels and see what is included. Better yet think about lemon juice, flavored vinegars, a bit of olive oil and you will save money and increase the flavor without the sugar.

Manage Better Foot Care with Diabetes

1. Socks always provide a layer between you and the shoe. An extra layer is very important.
2. Fabric - Diabetes socks should be a blend. Cotton is good for comfort and its natural allergy free properties, but it should contain some other fabric such as acrylic, spandex, polyester or synthetic material to help with a good fit and to stay in place. A good blend would be 50% cotton and 50% blend. The fabric should have some anti-static properties to help prevent rubbing which creates blisters. Blisters can lead to diabetic foot ulcers if not treated.
3. Colloidal silver - The silver is woven into the sock to help pull moisture away from the skin and actually absorbs the moisture. People with diabetes are more at risk for infections like athlete's foot or other fungus infections as well as bacterial infections, and perspiration will increase that risk. Any product that helps wick away moisture and has an anti-microbial property would be a benefit. Roughly 80% of the general population experience athlete's foot with the largest number coming from people with diabetes. The anti-microbial fibers will also reduce foot odor.
4. Elastic content - Athletic socks generally have large amounts of elastic which tends to constrict especially around the lower leg and ankle. This impairs blood flow and circulation - a danger to people with diabetes. Make sure you do not have skin indentations. Diabetes socks tend to have less elastic.
5. Fit - Try to find socks that are like a second skin to your foot. You should not have bunching or wrinkling which will cause blisters sores, hot spots, pressure points or ulcers.
6. Seams - Diabetes socks should not contain seams. They tend to create pressure points that also increase foot problems like ulcers. They are also uncomfortable. Even, smooth surfaces should rest against the foot.
7. Color - Depending on your needs, white socks are always the best when you have diabetes and foot issues. They allow you to quickly notice blood or discharge when sensation is diminished. White socks do not contain artificial color dyes or additives which could bleed into your skin when perspiring. Make sure the socks do not contain latex which causes allergies in a majority of people. Purchase a few pair of dark diabetic socks for special occasions.
8. Cushioning - Diabetes socks do offer extra comfort due to extra cushioning in the sole of the sock especially in the heel and toe area which lessens pressure. The toe area should be wider to give extra space and not cramp toes. Along with well fitted shoes cushioning can really protect diabetic feet.
9. Care of diabetic socks - The guidelines generally suggest that you wash your socks after each use with either cold or warm water on a gentle machine cycle with a mild detergent like Ivory. You can dry them on a short gentle cycle or air dry on a clothes line. It is suggested you purchase new diabetes socks at least every 6 months or when you notice signs of wear. If the elastic starts to pull, the cushioning starts to shrink or the fibers start to split- think new socks. Order a few pairs at a time. They may seem like an investment but your feet are worth it.